Evaluation of Self-ligating Brackets Plus Minor Surgery in Treating Crowded Cases of Malocclusion

The sample of this study will be chosen according the following steps:

* The examination of patients referred to the Department of Orthodontics at the University of Damascus Dental School (clinical examination, diagnostic plaster models, radiographic photos , external and internal oral photographs) then subjects who meet the inclusion criteria will be included in this trial.
* A random sample of 100 patients from the sampling frame will be chosen.
* An information sheet ( including the research objective and treatment plan in detail ) will be given to each candidate. Then consent forms will be collected from those who agree to participate.
* A random selection of 60 patients will be performed. Then a random distribution of these patients to 3 groups will be done.

• Self-Ligating Brackets (Device), also known as SLBs: These brackets can be opened and closed through the use of a sliding cap embedded into the design of these brackets. There is no need to use elastic modules to ligate the arch.
• Traditionally-Ligated Brackets (Device), also known as Non-SLBs: These brackets are used in the conventional manner, where the orthodontist is obliged to use elastic modules to engage the arch into the slot of the bracket.
• Corticotomy (Procedure), also known as Piezosurgery, Decortication: Corticotomy without flap elevations will be performed in order to induce acceleration in tooth movement during the orthodontic treatment in only one group.

Primary outcomes

• Duration of Alignment [This variable is going to be measured at the end of the alignment stage (i.e. expected to occur within four to six months)]: The time required in days will be calculated from the beginning of treatment till the end of the alignment stage
• Change in Little's Index [T0: one day before the beginning of treatment; T1: after one month; T2: after two months; T3: after three months; T4: after four months; T5: at the end of the alignment stage (which is expected to occur within 4 to 6 months)]: The irregularity of the upper and lower incisors is calculated by measuring the amount of deviation of the anatomic contact points between the six incisors in the horizontal direction in mm, since the sum of these measurements represents the value of the index (Little, 1975). The more the score is, the more crowded the case is.
• Change in inter-canine width lingually [T1: One day before the beginning of treatment; T2: at the end of the alignment stage (is expected within four to six months)]: The distance between the most lingual points on the lingual surface of the canines on the upper dental arch. This will be measured on plaster models.
• Change in inter-canine width [T1: One day before the beginning of treatment; T2: at the end of the alignment stage (is expected within four to six months)]: The distance between the cusp tips of the upper canines. This variable will be measured on plaster models.
• Change in Canine Rotation Angle [T1: One day before the beginning of treatment; T2: at the end of the alignment stage (is expected within four to six months)]: It is calculated by the angle formed between the median palatine suture and the line passing through the two medial and lateral contact points of the canine.
• Change in Lateral Incisor Rotation Angle [T1: One day before the beginning of treatment; T2: at the end of the alignment stage (is expected within four to six months)]: It is calculated by the angle formed between the median palatine suture and the line passing through the two medial and lateral contact points of the lateral incisor.
• Change in Central Incisor Rotation Angle [T1: One day before the beginning of treatment; T2: at the end of the alignment stage (is expected within four to six months)]: It is calculated by the angle formed between the median palatine suture and the line passing through the two medial and lateral contact points of the central incisor.

Sex: All, ages: 17 Years to 28 Years

Inclusion Criteria:

1. Age of patients: 17-28 years.
2. Severe crowding greater than 6 mm on the upper jaw in which orthodontic treatment requires at least two upper extraction.
3. The Little's Index of Irregularity is over 7 mm.
4. There is no previous orthodontic treatment.
5. The patient dose not take any drug may interfere with the tooth movement (Cortisone, NSAIDs, ...).
6. The patient has good oral health (i.e., Plaque Index is less or equal to 1 according to Loe and Silness (1963).
7. Class I or mild class II (ANB ≤ 5) or mild class III (ANB ≥ 0) skeletal relationship.
8. Overbite is between 0-4 mm.
9. There is no skeletal constriction on the upper jaw.
10. Full presence of all permanent teeth in the dental arch (except for third molars)

Exclusion Criteria:

1. Any systemic diseases that would affect tooth movement .
2. Any congenital syndromes or cleft lip and palate cases
3. Bad oral health

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• Heba Al-Ibrahim, DDS, Principal investigator, MSc student at the Orthodontic Department, University of Damascus Dental School, Damascus, Syria
• Mohammad Y Hajeer, DDS MSc PhD, Study chair, Associate Professor of Orthodontics, University of Damascus Dental School, Damascus, Syria
• Issam Khoury, DDS MSc PhD, Study director, Professor of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, University of Damascus Dental School, Damascus, SYRIA